Neuroimaging findings are sensitive and specific in diagnosis of tuberculous meningitis
- Author:
Mei-Ling Sharon Tai
;
Hazman Mohd Nor
;
Kartini Rahmat
;
Shanthi Viswanathan
;
Khairul Azmi Abdul Kadir
;
Norlisah Ramli
;
Fatimah Kamila Abu Bakar
;
Norzaini Rose Mohd Zain
;
Suhailah Abdullah
;
Jun Fai Yap
;
Ahmed Shaheed
;
Boon Seng Ng
;
Mohd Hanip Rafia
;
Chong Tin Tan
- Publication Type:Journal Article
- Keywords:
tuberculous meningitis;
stroke;
hydrocephalus;
tuberculoma;
leptomeningeal enhancement
- MeSH:
Tuberculosis, Meningeal
- From:Neurology Asia
2017;22(1):15-23
- CountryMalaysia
- Language:English
-
Abstract:
Objective: The primary objective of this study was to describe the neuroimaging changes of tuberculous
meningitis (TBM), and to determine the role of neuroimaging in the diagnosis of TBM. Methods:
Between January 2009 and July 2015, we prospectively recruited TBM patients in two hospitals in
Malaysia. Neuroimaging was performed and findings were recorded. The control consists of other types
of meningo-encephalitis seen over the same period. Results: Fifty four TBM patients were recruited.
Leptomeningeal enhancement was seen in 39 (72.2%) patients, commonly at prepontine cistern and
interpeduncular fossa. Hydrocephalus was observed in 38 (70.4%) patients, 25 (46.3%) patients had
moderate and severe hydrocephalus. Thirty four patients (63.0%) had cerebral infarction. Tuberculoma
were seen in 29 (53.7%) patients; 27 (50.0%) patients had classical tuberculoma, 2 (3.7%) patients
had “other” type of tuberculoma, 18 (33.3%) patients had ≥5 tuberculoma, and 11 (20.4%) patients
had < 5 tuberculoma. Fifteen (37.2%) patients had vasculitis, 6 (11.1%) patients had vasospasm. Close
to nine tenth (88.9%) of the patients had ≥1 classical neuroimaging features, 77.8% had ≥ 2 classical
imaging features of TBM (basal enhancement, hydrocephalus, basal ganglia / thalamic infarct, classical
tuberculoma, and vasculitis/vasospasm). Only 4% with other types of meningitis/encephalitis had ≥1
feature, and 1% had two or more classical TBM neuroimaging features. The sensitivity of the imaging
features of the imaging features for diagnosis of TBM was 88.9% and the specificity was 95.6%.
Conclusion: The classic imaging features of basal enhancement, hydrocephalus, basal ganglia/thalamic
infarct, classic tuberculoma, and vasculitis are sensitive and specific to diagnosis of TBM.
- Full text:P020170413313803682794.pdf
